Volume 14, Issue 8, Pages (August 2017)

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Date of download: 7/6/2016 Copyright © The American College of Cardiology. All rights reserved. From: Catheter-induced linear lesions in theleft atrium.

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Volume 14, Issue 8, Pages 1111-1118 (August 2017) Acute efficacy, safety, and long-term clinical outcomes using the second-generation cryoballoon for pulmonary vein isolation in patients with a left common pulmonary vein: A multicenter study Christian-Hendrik Heeger, MD, Verena Tscholl, MD, Erik Wissner, MD, PhD, FACC, FHRS, Thomas Fink, MD, Laura Rottner, MD, Peter Wohlmuth, PhD, MD, Barbara Bellmann, MD, Mattias Roser, MD, Shibu Mathew, MD, Christian Sohns, MD, Bruno Reißmann, MD, Christine Lemeš, MD, Tilman Maurer, MD, Francesco Santoro, MD, Johannes Riedl, MD, Britta Goldmann, MD, Ulf Landmesser, MD, FESC, Feifan Ouyang, MD, Karl-Heinz Kuck, MD, FESC, FACC, Andreas Rillig, MD, FEHRA, Andreas Metzner, MD Heart Rhythm Volume 14, Issue 8, Pages 1111-1118 (August 2017) DOI: 10.1016/j.hrthm.2017.05.003 Copyright © 2017 The Authors Terms and Conditions

Figure 1 Patient flowchart. LCPV = left common pulmonary vein; PV = pulmonary vein. Heart Rhythm 2017 14, 1111-1118DOI: (10.1016/j.hrthm.2017.05.003) Copyright © 2017 The Authors Terms and Conditions

Figure 2 Cryoballoon-based pulmonary vein in a patient with left common pulmonary vein (LCPV). Standard ablation approach. A: Angiography of LA and LCPV in left anterior oblique (LAO) 40°. B: Application of contrast medium through the CB2 into the LCPV. C: Schematic image of panel B. Note complete occlusion of the LCPV ostium. CB = cryoballoon; CS = coronary sinus catheter; LA = left atrium; TP = temperature probe; TSS = transseptal sheath. Heart Rhythm 2017 14, 1111-1118DOI: (10.1016/j.hrthm.2017.05.003) Copyright © 2017 The Authors Terms and Conditions

Figure 3 Cryoballoon-based pulmonary vein isolation in a patient with left common pulmonary vein (LCPV). Sequential ablation approach. A, B: Angiography of LA and LCPV in left anterior oblique (LAO) 40° and right anterior oblique (RAO) 30° view. C: Application of contrast medium through the CB2 into the superior branch (sup) of the LCPV (RAO 30°). D: Application of contrast medium through the CB2 into the inferior branch (inf) of the LCPV (LAO 40°). E, F: Schematic images of panels C and D. Note complete occlusion of the LCPV ostium; therefore a sequential strategy was used. CB = cryoballoon; CS = coronary sinus catheter; LA = left atrium; TP = temperature probe; TSS = transseptal sheath. Heart Rhythm 2017 14, 1111-1118DOI: (10.1016/j.hrthm.2017.05.003) Copyright © 2017 The Authors Terms and Conditions

Figure 4 Long-term clinical results. Kaplan–Meier curve demonstrates the relative proportion of patients in stable sinus rhythm after index PVI using the second-generation cryoballoon. A total of 64% (LCPV group) and 66% (control group) patients remained in sinus rhythm after mean follow-up of 1.9 ± 0.9 years (P = .820). LCPV = left common pulmonary vein; PVI = pulmonary vein isolation. Heart Rhythm 2017 14, 1111-1118DOI: (10.1016/j.hrthm.2017.05.003) Copyright © 2017 The Authors Terms and Conditions

Figure 5 Subgroup analysis. Long-term clinical results in group I vs group II. With regard to long-term clinical results, 14 of 37 patients (62%) in group I and 12 of 36 patients (67%) in group II remained in sinus rhythm after a median of 2.0 years (1.3, 3.2) in group I and 2.0 years (1.2, 2.5) in group II (P = .309). Group I = standard ablation approach; group II = sequential ablation approach. Heart Rhythm 2017 14, 1111-1118DOI: (10.1016/j.hrthm.2017.05.003) Copyright © 2017 The Authors Terms and Conditions

Figure 6 Location of electrical reconduction gaps in previously isolated pulmonary veins. Septal and lateral pulmonary vein ostia are divided into 4 segments (anterosuperior, anteroinferior, posterosuperior, posteroinferior). Numbers indicate the number of reconduction gaps found in each segment. LCPV = left common pulmonary vein; RIPV = right inferior pulmonary vein; RSPV = right superior pulmonary vein. Heart Rhythm 2017 14, 1111-1118DOI: (10.1016/j.hrthm.2017.05.003) Copyright © 2017 The Authors Terms and Conditions

Supplementary Figure 1 Heart Rhythm 2017 14, 1111-1118DOI: (10.1016/j.hrthm.2017.05.003) Copyright © 2017 The Authors Terms and Conditions